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There has been much discussion of population health management coupled with predictive analytics recently in the health care field. Why? Most who are discussing these topics see it as a means of improving the health of patients while reducing the costs of doing so. Providing better care at lower costs is becoming necessary as payers are beginning to pay for quality outcomes as they move away from fee-for-service.

What is population health and how does predictive analytics fit in? Let me begin by defining population health and illustrate predictive analytics. In statistics, population refers to the complete set of objects of interest to the investigation. For instance, it could be the temperature range of adolescents with measles. It could be the individuals in a rural town who are prediabetic. These two are of interest in healthcare. Population also applies to any other field of research. It could be the income level of adults in a county or the ethnic groups living in a village.

Typically, population health management refers to managing the health outcomes of individuals by looking at the collective group. For instance, at the clinical practice level, population health management would refer to effectively caring for all the patients of the practice. Most practices segregate the patients by diagnosis when using population health management tools, such as patients with hypertension. Practices typically focus on patients with high costs for care so that more effective case management can be provided to them. Better case management of a population typically leads to more satisfied patients and lower costs.

Population health from the perspective of a county health department (as illustrated in last month’s newsletter) refers to all the residents of a county. Most services of a health department are not provided to individuals. Rather, the health of residents of a county is improved by managing the environment in which they live. For instance, health departments track the incidence of flu in a county in order to alert providers and hospitals so that they are ready to provide the levels of care needed.

You should be able to see that the population whose health is being managed depends upon who is providing the service. Physician practices’ population is all the patients of the practice. For county health departments it is all residents of a county. For the CDC it is all residents of the United States.

Once the population is identified, the data to be collected is identified. In a clinical setting, a quality or data team is most likely the body that determines what data should be collected. Once data is collected, trends in care can be identified. For instance, a practice may find that the majority of the patients who are identified as being hypertensive are managing their condition well. The quality team decides that more can be done to improve the outcomes for those who do not have their blood pressure under control. Using the factors from the data that it has collected the team applies a statistical approach called predictive analytics to see if can find any factors that may be in common among those whose blood pressure is not well managed. For instance, they may find that these patients lack the money to buy their medication consistently and that they have trouble getting transportation to the clinic that provides their care service. Once these factors are identified, a case manager at the clinic can work to overcome these barriers.

I will finish this overview of population health management and predictive analytics with two examples of providers using the approach correctly. In August 2013 the Medical Group Management Association presented a webinar featuring the speakers Benjamin Cox, the director of Finance and Planning for Integrated Primary Care Organization at Oregon Health Sciences University, an organization with 10 primary care clinics and 61 physicians, and Dr. Scott Fields, the Vice Chair of Family Medicine at the same organization. The title of the webinar was “Improving Your Practice with Meaningful Clinical Data”. Two of the objectives of the webinar were to define the skill set of their Quality Data Team, including who the members were, and describing the process of building a set of quality indicators.

The clinics were already collecting a large variety of data to report to various groups. For instance, they were reporting data for “meaningful use” and to commercial payers as well as employee groups. They decided to take this data and more and organize it into scorecards that would be useful to individual physicians and to practice managers at each clinic. Some of the data collected was patient satisfaction data, hospital readmission data, and obesity data. Scorecards for physicians were designed to meet the needs and requests of the individual physicians as well as for the practice as a whole. For instance, a physician could ask to have a scorecard developed for him that identified individual patients whose diabetes indicators showed that the patient was outside of the control limits for his diabetes. Knowing this, a physician could devote more time to improving the quality of life of the patient.

Scorecards for the clinic indicated how well the physicians at the site were managing patients with chronic conditions as a whole. With predictive analytics the staff of the clinic could identify which processes and actions helped improve the health of the patients. Providing more active case management may have been demonstrated to be effective for those with multiple chronic conditions.

Mr. Cox and Dr. Fields also stated that the quality data team members were skilled at understanding access, structuring data in meaningful ways, at presenting data to clinicians effectively and in extracting data from a variety of sources. The core objectives of the data team were to balance the competing agendas of providing quality care, making sure that operations were efficient and that patient satisfaction was high.

A second example of population health management focuses on preventing cardiovascular disease in a rural county in Maine-Franklin County. Over a 40-year period, starting in the late 1960’s, a volunteer nonprofit group and a clinical group worked together to improve the cardiovascular health of the residents of the county. As the project advanced, a hospital joined in the efforts.

At the beginning of the prevention efforts, the cardiovascular health of this poor county was below the state average. As volunteers and clinical groups became more active in improving the health of its residents, various cardiovascular measures improved significantly and actually were better in some respects than more affluent counties in the state that had better access to quality health services. The improvements were driven by volunteers who went out into the community to get those identified as being at risk of developing cardiovascular problems involved in smoking cessation classes, in increasing their physical activity and in improving their diets. This led to lowering blood pressure, lowering cholesterol rates and improving endurance.

The results and details of this 40-year effort in Franklin County has been published in the Journal of the American Medical Association in January 2015. The article is “Community-wide CVD prevention programs linked with improved health outcomes”.

As you can see, a population level approach to healthcare provides effective results. A clinic can improve the outcomes of its patients with chronic diseases while balancing costs through improved efficiency by focusing on data at the population level. A community can improve the lives of its residents by taking a population level approach to preventive care. Population level approaches to healthcare are varied and can be very successful if population level theory is correctly implemented. Better results can be obtained pairing it with predictive analytics.

Donald Bryant helps healthcare providers meet their challenges. Go to http://www.bryantsstatisticalconsulting.com to get the free article “7 Challenges in Healthcare and How to Solve Them” with tips you can use to start improving patient health, improving the bottom line, finding more time to get things done and to learn more about Lean Healthcare. Mr. Bryant is a certified Lean Healthcare facilitator.

For people who depend on any type of private or company insurance to cover the cost of their health needs, the question of whether or not the health insurance policy covers mental health problems is a crucial one for a number of reasons.

The idea of a split between physical health and mental health is an old one, and is a fairly arbitrary decision as to which is which some of the time. From a point of view of health insurance, classifying illnesses or diseases can determine whether or not the insurance company will pay for them, and for many people with mental health issues that can literally be a life or death process.

The term mental health can relate to a condition ranging from a fairly mild form of depression through to serious conditions of clinical depression, schizophrenia, alcoholism, full-blown psychotic episodes etc.

Any health insurance policy should specify exactly what types of illness or disease it is willing to provide cover for and those which it is not. This will also include what it specifies as a type of mental health problem or issue and whether or not the insurance policy provides any type of cover for it.

One of the reasons people are wary of health insurance plans with relation to mental health issues, is that often any type of treatment for a mental health issue relates either to what is known as a talking therapy, or some type of pharmaceutical drug based regime.

Any type of talking therapy that is likely to be effective is likely to be a relatively long-term process, depending upon the nature and seriousness of the illness. Any insurance policy that does cover specified mental health conditions will also provide very strict criteria as to what type of talking therapy is covered, for how long and by whom the talking therapy can be carried out by.

The other issue to be really aware of when looking at any type of mental health coverage under a health insurance plan is the nature of deductibles, co-pay and co-insurance. These terms are essentially ways of getting the person who is insured under the policy to bear some of the cost of the treatment on an ongoing basis in relation to the insurance company.

Most people are familiar with the idea of a deductible, sometimes called an excess, in a policy, but any health insurance policy needs to be looked at carefully in terms of what it’s deductibles are. This is because there are often several different deductibles applicable to the same policy, each for differing amounts and applying to different sections of the policy.

This means that a health insurance policy could have both an individual and a family deductible. This deductible could be separate from another deductible that would apply to specific types of drugs, normally where a distinction is made between a generic and a brand-name drug. The amounts involved in terms of these deductibles can be significant, and when taken in addition to any co-pay or co-insurance amounts can stack up into a sizeable burden that the individual will have to carry for themselves.

In summary, as with any insurance policy, it is important before taking out the policy to have complete clarity about what is and is not covered, as the level of coverage and the specifics of what is and is not covered will vary widely between health insurance policies.

Peter Main is freelance writer who writes extensively about health, healthcare and health insurance with a particular focus on current issues and debates, such as the state of healthcare reform and how it impacts on peoples lives.

Nearly 3 million men and women go through the devastating trauma of divorce each year in the United States. For many of these individuals, the strain is intensified by the fact that they took a “hands off” approach to finances during the marriage. Faced with divorce, these “non-financial” spouses are at a disadvantage when it comes to dividing up the marital estate and planning for long-term financial stability.

But all is not lost. Knowledge is power, and learning about the common financial pitfalls of divorce can help the non-financial spouse face life during and after a divorce with confidence.

Not Identifying All The Assets

For a non-financial spouse, understanding the assets the couple owns can be a challenging proposition, especially if his or her spouse has been secretive with financial management during the marriage. It is no surprise that assets are often overlooked by the non-financial spouse during divorce. Yet even if an asset is unwanted, it has value and can be traded for another asset the non-financial spouse may want. For this reason, it is critically important that all assets be identified early on in the divorce proceedings, even if this means hiring a forensic accountant (a sort of financial detective) to uncover them. Before the divorce begins is an excellent time to start collecting paystubs, bank and investment account statements, insurance policies and any other documents related to finances.

Mixing Money And Emotions

Divorce brings with it an emotional roller-coaster, especially when it comes to marital assets and property division. While it may seem like a good idea to keep the marital home out of spite or nostalgia, any decision on which assets to demand in a divorce should be made on each party’s long-term best interest – not revenge. While the divorcing parties may loathe each other, transferring those feelings to the “nuts and bolts” of issues like property division only benefits the lawyers. At the end of the day, fighting just to fight will only deplete the marital estate.

Not Fighting For A Fair Share

When it comes to property division in divorce, the general rule of thumb is “equitable division.” While this doesn’t necessarily mean equal, it does mean that each spouse is entitled to his or her fair share of the assets amassed during the marriage. Often times, the non-financial spouse is too intimidated or exhausted to fight for his or her rightful share. Yet to ensure long-term financial security, each spouse must stand up and fight for what he or she deserves. Once the divorce is over and the property divvied up, there is no going back to get more.

Inadequate Records

One of the first things any divorce lawyer will ask from a new client is documentation related to the couple’s finances and assets. Copies of bank statements are usually not enough. If a divorce action is contemplated or has already begun, collecting as much documentation as possible is absolutely required. Tax returns, wills, trusts, loan applications and statements, investment and brokerage statements, insurance policies, deeds for real property and credit card statements are just a few of the items that should be located and copied. If a spouse owns a business, obtaining as much documentation as possible related to that business will go a long way towards finding hidden assets.

Ignoring Reality

While it may seem appealing to bury one’s head in the sand in the midst of the chaos caused by divorce, this is one of the worst things that can be done. So is adopting the attitude of “let the attorneys handle everything.” While legal counsel is there to vigorously represent their client’s best interest, only the client knows what is truly important. Taking an active role in the process, including participation in negotiations, focusing on practical matters, and making decisions based on facts rather than emotion, will all go a long way toward creating a strong post-divorce financial future.

Not Enough Cash On Hand

Once a divorce is filed, expenses will explode. Often times, one spouse will leave the marital home, resulting in a second set of living expenses that didn’t exist before. Add to this legal fees, court costs, therapy bills and other unexpected expenses and even a spouse with a good salary will find themselves financial stretched. The best time to financially prepare for divorce is before it begins. This is the time to amass as much cash as possible to help weather the tide.

Not Enough Preparation

A divorce isn’t over in a week or even a few months. On average, most divorces take up to a year to be finalized. In some cases, a divorce can linger on for much longer. Understanding that this is a marathon and not a sprint, it makes sense to prepare properly before entering the race. Anyone contemplating divorce should first consult with legal and financial professionals and educate themselves about the process. Timing is also important. If a spouse is expecting a financial windfall (e.g. annual bonus, stock option grant, etc.), the other spouse filing for divorce before that happens could be a costly mistake. Social security is another consideration. A marriage of 10 years or more entitles one spouse to collect benefits based on the other spouse’s earning record.

Not Mentally Preparing

The only certainty that divorce brings is that lives will be thrown into complete upheaval. It is important to mentally prepare for all possibilities. While the worst usually does not happen, speed bumps along the way can be amplified if they weren’t at least considered beforehand. It is important to consider even the most far-fetched scenarios – a spouse disappears and refuses to pay support, a major illness occurs, all financial resources are drained during the divorce. Thankfully, these “what ifs” don’t often occur. Yet, by thinking through the scenarios puts whatever actually happens is put into perspective. It helps to keep panic at bay.

Failing To Look Forward

For many spouses, their career was given up to raise a family. When divorce occurs, these spouses are disadvantaged in terms of re-entering the workforce. It is important to stay strong and begin developing new skills sooner rather than later. Resources such as career counselors at local universities, job centers or community colleges can help to identify suitable interests and opportunities.

Allowing Panic To Take Control

The divorce process seemingly brings with it a crisis around every corner. Whether it is an unexpected bill, escalating legal fees or a stubborn spouse who challenges every decision, there is no shortage of things that will keep a divorcing person up at night. Countless hours are spent tossing and turning, worrying about all the “what ifs.” Instead of letting these worries become all-consuming – and making poor financial decisions based on fear rather than logic – it is important to find some means of stress relief during the divorce. Whether it is yoga, kickboxing or simply writing down your fears and revisiting them in the clear light of day, allowing panic to take control during a divorce will only have a negative long-term impact.

Ignoring Tax Consequences

A major component of any divorce is dividing up the marital assets. Real estate, retirement accounts and investments each come with their own set of pros and cons, especially when it comes to liquidity and taxes. For example, it may be tempting to want the marital home, but that may not be the best financial decision. Maintenance and upkeep are often underestimated, and it can quickly become an albatross rather than an abode. Likewise, accepting a retirement account instead of cash could tie up assets for decades or more. It is important to consult with an accounting and tax professional to ensure that the full implications – both short- and long-term – of any final property division are understood.

Failing To Get Solid Professional Advice

While it may be tempting to save a few (thousand) dollars by trying to go it alone in a divorce, this is usually a very unsound financial decision in the long run. Divorce can be a very complicated process, and without sufficient legal and financial knowledge rights can be unwittingly given up. Hire the best attorney you can afford – not the cheapest. The old adage, you get what you pay for is usually true. Likewise, consider a forensic accountant if you believe assets are being hidden. A divorce financial professional can also be one of the best investments to secure a solid financial future.